Optimizing quality of care for couples with recurrent miscarriage

The first aim of our research was to make a step forwards to decipher the enigma of the definition of recurrent miscarriage. We showed that the risk of underlying antiphospholipid syndrome and carrier status of chromosomal abnormalities in couples with recurrent miscarriage is not related to obstetric history. The sequence - consecutive or non- consecutive- of preceding miscarriages in patients with APS or carrier couples, was not different from controls with unexplained recurrent miscarriage. In patients with APS, the number of preceding miscarriages and maternal age were not different from controls with two or more unexplained recurrent miscarriages. It can therefore not be justified that only women with three or more consecutive miscarriages are identified as "recurrent miscarriage patients" and are eligible for diagnostic testing to identify underlying risk factors. Consecutive should therefore not be part of the definition of recurrent miscarriage. Studies on diagnostics and therapy in recurrent miscarriage should also include couples with two first trimester recurrent non-consecutive miscarriages.
The second aim was to study and improve implementation of the revised Dutch guideline on recurrent miscarriage. With the developed implementation strategy a significant increase in adherence to most aspects of the guideline was achieved. Although the strategy is relatively simple and easily adjustable, the implementation process was time consuming; with repetitive feedback and consultation during indicator development, focusgroup interviews, and feedback after the first measurement of guideline adherence let alone the effort needed to identify the patients in retrospect. The result of this thesis might work as a framework for future implementation within obstetrics and gynaecology.